Objectives to study the effect of antirheumatic therapy administered in accordance with “treat-to-target” principles on NT-proBNP level in early rheumatoid arthritis (RA) patients (pts) during 18-month follow-up
Methods A total of 66 early RA pts (ACR/EULAR criteria, 2010) were included in the study: 71% of women, age 56 [46;61] years, disease duration 6 [4;8] months; DAS28 5.3 [5.0;6.2], positive for ACCP (100%), RF (87%), without prior administration of DMARDs and glucocorticoides. The control group consisted of 27 healthy subjects, which were matched by sex and age. Methotrexate (MT) therapy was started in all pts with an escalation of the dose up to 30 mg/week subcutaneously. Incase of no remission 3 months (mon) later, MT was added with biologic therapy (BT): Adalimumab, Certolizumab pegol, Abatacept. After 18 mon 27 (41%) pts achieved remission. Antihypertensive therapy was administered in 51 (77%) pts: ACE inhibitors, ARBs, beta-blockers, calcium antagonists, diuretics. The normal range for NT-proBNP was less than 125 pg/ml.
Results At baseline the concentration of NT-proBNP in early RA pts (125 [65;208] pg/ml) was higher than in control group (52 [40;69] pg/ml), p<0,05. In 32 (49%) RA pts NT-proBNP level were higher than normal. Pts with elevated NT-proBNP level compared to pts with normal one were older (60 [56;65] vs 50 [35;55] years), have a higher frequency of carotid atherosclerosis (85% vs 43%), coronary artery calcinosis (69% vs 22%), chronic heart failure (CHF) (20% vs 0%), ischemic heart disease (28% vs 5%), as well as a higher BMI (28 [24;31] vs 24 [22;29] kg/m2), CRP (34 [13;78] vs 14 [3;41] mg/l), p<0,05 for all cases. The frequency of dyslipidemia, abdominal obesity, diabetes mellitus were not obtained between the groups. After 18 mon NT-proBNP level decreased from 125 [65;208] to 68 [33;115] pg/ml, p<0,05. There were also reduction in the number of pts with high NT-proBNP level from 49% to 21%, p<0,05. Pts who achieved remission showed a decrease in the number of pts with high NT-proBNP level (from 41% to 7%), p<0,05, and those who disease activity remained showed a decrease in the number of pts with high NT-proBNP level (from 54% to 31%), p<0,05. In group of MT+BT revealed a more pronounced decrease in NT-proBNP level (from 50% to 15%), p<0,05, than in group MT (46% vs 31%), p>0,05. The most pronounced decrease NT-proBNP level was in pts who achieved remission on MT+BT therapy (Tabl.1). There were correlation between ΔNT-proBNP and ΔCRP (r=0,4;p<0,05).
Conclusions At baseline NT-proBNP concentration in early RA pts were higher than in control group and its level correlated with age, traditional risk factors of cardiovascular disease (CVD), CVD, disease activity, markers of inflammation. Achieved remission especially in case of MT+BP therapy leads to a more pronounced reduction in NT-proBNP level. That can contribute to reduce the risk of CHF.
Disclosure of Interest None declared